Benefits of a Regional Evidence-Based Practice Fellowship Program: A Test of the ARCC Model.

BACKGROUND: The Advancing Research and Clinical practice through close Collaboration (ARCC) model postulates that improvement in nurses' evidence-based practice (EBP) beliefs results in improved EBP implementation, which in turn improves nurse-related outcomes, such as nurses' job satisfaction and group cohesion. However, there is a dearth of interventional studies that evaluate the relationships among these variables. AIMS: This study evaluated whether a regional EBP fellowship program improved participants' EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness, and examined the relationships among these improvements, using structural equation modeling. METHODS: A pretest-posttest design was used among three annual cohorts of a regional, 9-month EBP fellowship program, from 2012 to 2014, in San Diego, California. Matched pretest and posttest questionnaires, including EBP Beliefs, EBP Implementation, Job Satisfaction, Group Cohesion, and Group Attractiveness scales, were analyzed (N = 120). RESULTS: Paired t-tests showed statistically significant improvements in EBP beliefs, EBP implementation, job satisfaction, and group cohesion (p < .05). Structural equation modeling showed that improvement in EBP implementation had no direct effect on improvements in job satisfaction, group cohesion, or group attractiveness. However, improvement in EBP beliefs had direct effects on improvements in job satisfaction (ß = .24; p = .002) and group attractiveness (ß = .22; p = .010). LINKING EVIDENCE TO ACTION: A regional, collaborative EBP fellowship program was effective in improving EBP beliefs, EBP implementation, job satisfaction, and group cohesion. Improvement in EBP beliefs appears to have had direct effects on improvements in job satisfaction and group attractiveness. Regional fellowship programs that educate and support EBP champions and their mentors may enhance EBP adoption in nursing practice across multiple health care institutions.

Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants.

BACKGROUND: A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. AIMS: This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. METHODS: A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. RESULTS: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (ß = 0.33; p <.001) and job satisfaction (ß = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. LINKING EVIDENCE TO ACTION: In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

Regional evidence-based practice fellowship program: impact on evidence-based practice implementation and barriers.

This quasi-experimental, pre- and posttest study evaluated the impact of a 9-month collaborative regional evidence-based practice (EBP) fellowship program on practice, attitude, knowledge, and perceived barriers associated with implementation of EBP. Three annual cohorts (N=142) of nurses attending a fellowship program from 2008 to 2010 participated in this study. Paired t tests showed statistically significant increases in practice (+.82; p<.001) and knowledge/skills (+.78; p<.001) associated with EBP, but showed no change in attitude (+.16; p=.198). All four Barriers subscales showed statistically significant decreases (-.10 to -.31; p=.036 to <.001). Hierarchical multiple regression analyses showed that the barriers explained 6.8%, 8.9% and 13.9% of variances in practice, attitude and knowledge/skills, respectively. The collaborative regional fellowship program improved the practice and knowledge/skills associated with EBP. The barriers were significant predictors of the EBP implementation among the targeted group of nurses participating in the fellowship program.

Family-provider alliance program in intensive care units.

This nonrandomized controlled study evaluated the effects of Family-Provider Alliance Program on nurses' perception of therapeutic alliance, job satisfaction, and quality of care. A total of 275 nurses were included in the study: 206 nurses in the ICUs participated in the Program and 69 in the control group did not. Mean postinterventional Kim Alliance Scale-Provider score was improved not only in the experimental group (+0.87; p = .01), but also in the control group (+1.37; p = .016). However, Empowerment subscale mean score was improved in the experimental group alone (+0.34; p = .006). Hierarchical multiple regression analyses indicated that family-nurse therapeutic alliance explained 7.2% and 11.4% of the variance in nurses' job satisfaction and perceived quality of care, respectively. The Program was marginally effective in improving nurses' perception of family empowerment. The quality of family-nurse therapeutic alliance predicted small to moderate fractions of the variance in nurses' job satisfaction and perceived quality of care.

Faculty knowledge, attitudes, and perceived barriers to teaching evidence-based nursing.

This study measured the knowledge, attitudes, and perceived barriers to teaching evidence-based practice (EBP) among nursing faculty at two schools of nursing with baccalaureate and master's level programs in southwestern United States. Survey instruments included a demographic survey, the Evidence-Based Practice Questionnaire, and the BARRIERS to Research Utilization Scale. Descriptive statistics, Pearson's correlations, and hierarchical multiple regression procedures were employed to analyze the data. The results indicated that master's prepared faculty had significantly higher mean scores in the practice of EBP as compared with doctorally prepared faculty, and although faculty positively viewed EBP, their attitude toward EBP was more positive than their knowledge/skills and practice of EBP. One of the major findings in the study was that traditional research knowledge and skills among faculty does not necessarily translate to a supportive attitude or knowledge of the EBP process or skills in acquiring and appraising evidence. Understanding faculty's knowledge, attitudes, and practice of teaching EBP is a critical step to successfully transforming the school's culture to an evidence-based framework for teaching nursing practice, integrating of EBP content into curricula, and ensuring student mastery and appreciation of EBP.

Evidence-based architectural and space design supports Magnet® empirical outcomes.

This department expands nursing leaders' knowledge and competencies in health facility design. The editor of this department, Dr Jaynelle Stichler, asked guest authors, Drs Ecoff and Brown, to describe the process of using the conceptual models of a nursing evidence-based practice model and the Magnet Recognition Program® as a structured process to lead decision making in the planning and design processes and to achieve desired outcomes in hospital design.

Multi-institutional study of barriers to research utilisation and evidence-based practice among hospital nurses.

AIMS: The study aims were to explore the relationships between perceived barriers to research use and the implementation of evidence-based practice among hospital nurses and to investigate the barriers as predictors of implementation of evidence-based practice. BACKGROUND: Evidence-based practice is critical in improving healthcare quality. Although barriers to research use have been extensively studied, little is known about the relationships between the barriers and the implementation of evidence-based practice in nursing. DESIGN: Cross-sectional study. METHOD: Data were collected between December 2006-January 2007 for this cross-sectional study using computerised Evidence-Based Practice Questionnaire and BARRIERS surveys. A convenience sample (n=1301) of nurses from four hospitals in southern California, USA, participated. Hierarchical multiple regression analyses were performed for each of the three dependent variables: practice, attitude and knowledge/skills associated with evidence-based practice. BARRIERS subscales were used as predictor variables. RESULTS: The perceived barriers to research use predicted only 2·7, 2·4 and 4·5% of practice, attitude and knowledge/skills associated with evidence-based practice. Conclusions. It was unexpected that the barriers to research use predicted such small fractions of practice, attitude and knowledge/skills associated with evidence-based practice. The barriers appear to have minimal influence over the implementation of evidence-based practice for most hospital nurses. RELEVANCE TO CLINICAL PRACTICE: In implementing evidence-based practice, the focus on barriers to research use among general nursing staff may be misplaced. Further studies are needed to identify the predictors of evidence-based practice and to identify the subset of nurses who are most amenable to adopting evidence-based practice.

Predictors of knowledge, attitudes, use and future use of evidence-based practice among baccalaureate nursing students at two universities.

Nursing students are strategically positioned to influence adoption of evidence-based practice within the nursing profession. The purpose of this study was to identify the predictors of knowledge, attitudes, use and future use of evidence-based practice among baccalaureate nursing students at two universities. A cross-sectional survey design was used to study a convenience sample of 436 nursing students (response rate of 63.3%) enrolled at two baccalaureate nursing programs at the beginning of 2007 fall semester in the United States. The surveys included demographic questionnaire and knowledge, attitudes and behaviors questionnaire for evidence-based practice. EBP Knowledge, Attitudes toward EBP and Future Use of EBP subscales demonstrated statistically significant increase in mean scores with advancing academic levels. Confidence in clinical decision-making and clinical preparedness had moderate positive correlation with EBP Use and Future use of EBP. Simultaneous multiple regression analyses indicated that the clinical preparedness and confidence in clinical decision-making were statistically significant predictor variables for EBP use and Future use of EBP. Clinically well-prepared nursing students with high confidence in clinical decision-making are most likely to use evidence-based practice, both in the present and the future.

Evidence-based practice-focused interactive teaching strategy: a controlled study.

AIM: This paper is a report of a study to evaluate the effectiveness of the evidence-based practice (EBP)-focused interactive teaching (E-FIT) strategy. BACKGROUND: Although EBP is a mandatory competency for all healthcare professionals, little is known about the effectiveness of E-FIT in nursing. METHODS: Aquasi-experimental, controlled, pre- and post-test study involving senior, 4th-year nursing students (N = 208) at two nursing schools in the USA was carried out from August 2007 to May 2008. The experimental group (n = 88) received the E-FIT strategy intervention and the control group (n = 120) received standard teaching. A Knowledge, Attitudes and Behaviors Questionnaire for Evidence-Based Practice was used to assess the effectiveness of the E-FIT strategy. RESULTS: Independent t-tests showed that the experimental group had statistically significant higher post-test Evidence-Based Practice Knowledge (mean difference = 0.25; P = 0.001) and Evidence-Based Practice Use (mean difference = 0.26; P = 0.015) subscale scores compared to the control group, but showed no statistically significant differences in Attitudes toward Evidence-Based Practice and Future Use of Evidence-Based Practice (mean difference = 0.12; P = 0.398 and mean difference = 0.13; P = 0.255 respectively). Hierarchical multiple regression analyses of the post-test data indicated that the intervention explained 7.6% and 5.1% of variance in Evidence-Based Practice Knowledge and Evidence-Based Practice Use respectively. CONCLUSION: The EBP-focused interactive teaching strategy was effective in improving the knowledge and use of EBP among nursing students but not attitudes toward or future use of EBP.

Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center.

AIM: This paper is a report of a study to describe nurses' practices, knowledge, and attitudes related to evidence-based nursing, and the relation of perceived barriers to and facilitators of evidence-based practice. BACKGROUND: Evidence-based practice has been recognized by the healthcare community as the gold standard for the provision of safe and compassionate healthcare. Barriers and facilitators for the adoption of evidence-based practice in nursing have been identified by researchers. Healthcare organizations have been challenged to foster an environment conducive to providing care based on evidence and not steeped in ritualized practice. METHODS: A descriptive, cross-sectional research study was conducted in 2006-2007 with a convenience sample of 458 nurses at an academic medical center in California (response rate 44.68%). Two reliable and valid questionnaires were electronically formatted and administered using a secured website. Relationships between responses to the two instruments were examined and results compared with previously published data. RESULTS: Organizational barriers (lack of time and lack of nursing autonomy) were the top perceived barriers. Facilitators were learning opportunities, culture building, and availability and simplicity of resources. Statistically significant correlations were found between barriers and practice, knowledge and attitudes related to evidence-based practice. CONCLUSION: Similar barriers to the adoption of evidence-based practice have been identified internationally. Educators must work with managers to address organizational barriers and proactively support evidence-based practice.

Hydrocarbon contamination changes the bacterial diversity of soil from around Scott Base, Antarctica.

A combination of culture-independent and culturing methods was used to determine the impacts of hydrocarbon contamination on the diversity of bacterial communities in coastal soil from Ross Island, Antarctica. While numbers of culturable aerobic heterotrophic microbes were 1-2 orders of magnitude higher in the hydrocarbon-contaminated soil than control soil, the populations were less diverse. Members of the divisions Fibrobacter/Acidobacterium, Cytophaga/Flavobacterium/Bacteroides, Deinococcus/Thermus, and Low G+C gram positive occurred almost exclusively in control soils whereas the contaminated soils were dominated by Proteobacteria; specifically, members of the genera Pseudomonas, Sphingomonas and Variovorax, some of which degrade hydrocarbons. Members of the Actinobacteria were found in both soils.